Payor Contract Administrator F/T Day Remote

Inspire health. Serve with compassion. Be the difference.

Job Summary

Performs operational and financial analysis to evaluate assigned projects in support of managed care operations, services, and initiatives. Performs proactive servicing of contracts and analysis of contract performance to include variance support and payor engagement. Resolves contracting and reimbursement issues. Prepares findings into summaries and documents suitable for leadership presentation. Provides managed care education and communication.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose:  Inspire health.  Serve with compassion.  Be the difference.

• Supports the affiliate with resolution of issues related to managed care contracts for facilities, departments and employed physicians. Responsible for communicating with affiliate and monitoring contractual adjustments, communication of contract policies and procedures, and contract compliance issues. Escalates issues that impact company goals.

• Works closely with Provider Enrollment to help resolve any payor issues and participates on monthly enrollment calls. 

• Schedules and participates in meetings with affiliate administrators, directors, and medical directors on issues related to managed care contracting strategies and provides ongoing education and communication of local and national managed care trends.

• Works closely with facility and physician revenue cycle departments to remediate contractual issues and assist in facilitating reimbursement related issues as they arise.  Participates in monthly revenue cycle payor calls. 

• Assists department leaders on managed care issues with outside organizations such as managed care organizations, the State Hospital Association and other health care providers.  Represents the Affiliate when communicating or meeting with representatives from Managed Care Organizations (HMOs, PPOs, Insurance Networks). Supports management and interacts with Directors or Vice Presidents when conducting business with managed care organizations. Responsible for assisting in and maintaining and enhancing relationship with managed care organizations.

• Supports and delivers educational programs and seminars for staff, provider personnel and clients. Assists as needed with projects of significant scope that have Affiliate implications. Works with department heads to obtain additional resources as needed.

• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - Bachelor's degree

• Experience - Five (5) years of managed care experience. 

In Lieu Of

• In lieu of the education and experience requirements noted above, the following combination of education, training and/or experience may be considered an equivalent substitution: Master's degree and two (2) years of managed care experience.

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills and Abilities

• NA

Work Shift

Day (United States of America)

Location

Independence Pointe

Facility

7001 Corporate

Department

70019069 Managed Care Contracting

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.